Mallet Finger: Causes, Symptoms, Treatment, and the Role of Physiotherapy
▫️Written by John Keller
✅ Reviewed by Dr. Jenny Hynes on FEBRUARY 14, 2024
Mallet finger is a common but often underestimated injury that affects the fingertip's ability to straighten, resulting from damage to the extensor tendon at the finger's distal joint. This condition might seem minor, but its impact on finger functionality and daily life can be significant, hindering basic tasks like typing, gripping, or even dressing. Understanding the implications of mallet finger is crucial for timely and effective management to prevent long-term dysfunction.
Seeking professional care is essential for anyone experiencing the hallmark sign of mallet finger - the inability to straighten the fingertip. Healthcare professionals, particularly those specializing in physiotherapy, play a pivotal role in the recovery process. Physiotherapy offers a range of treatments aimed at restoring function, strength, and flexibility to the injured finger. Through a combination of targeted exercises, splinting techniques, and education on finger care, physiotherapists can guide patients through their recovery journey, optimizing outcomes and minimizing the risk of complications.
The journey to recovery from mallet finger involves more than just physical healing; it's about regaining the ability to perform everyday activities without limitation. By emphasizing the importance of professional care and the role of physiotherapy, individuals can navigate the recovery process with confidence, ensuring a return to normal function and quality of life.
What is a Mallet Finger?
Mallet finger is a condition characterized by the inability to straighten the distal end of a finger, resulting from damage to the extensor tendon at the finger's tip. In simpler terms, it's as if one of the crucial cables (tendons) that help move the finger has been damaged, leading to a persistent bend at the finger's end, preventing it from straightening fully.
This injury frequently occurs in individuals involved in sports, where an unexpected impact from a ball forces the finger to bend excessively (Peterson & Renström, 2007). However, sports injuries are not the sole cause; everyday accidents such as striking the finger against a hard object or catching it in a door can also result in mallet finger (Stern & Kastrup, 1988). Essentially, any sudden force that overstretches or tears the tendon at the finger's tip can cause this condition.
Leaving mallet finger untreated can lead to significant complications, including permanent bending of the finger, reduced finger function, and even arthritis in the affected joint, complicating daily tasks like typing or holding objects (Bendre et al., 2005). The deformity not only affects the physical appearance but can also impair the finger's utility, emphasizing the importance of timely and appropriate treatment.
Research underscores the necessity of early intervention to mitigate the risk of long-term deformities and functional impairments associated with mallet finger. For instance, a study by Calfee & Sommerkamp (2009) demonstrated the effectiveness of splinting in achieving satisfactory outcomes for non-operative treatment of mallet finger injuries. Furthermore, Glickel et al. (2008) highlighted that prompt and proper management is crucial for preventing joint stiffness and ensuring the best possible recovery.
Causes and Risk Factors of Mallet Finger
Mallet finger injuries commonly result from direct trauma to the fingertip, which can occur in several ways. One of the most frequent causes is a direct blow to the tip of the finger, often seen in sports when a ball or object strikes the finger, forcing it to bend further than its natural range of motion. Another cause is forceful hyperextension, where the finger is pushed backward too aggressively, damaging the tendon responsible for straightening the fingertip (Bendre et al., 2005).
Risk factors for developing mallet finger primarily involve activities or professions that expose individuals to higher chances of finger injuries. Athletes, particularly those involved in ball sports like basketball, volleyball, or baseball, are at a significant risk due to the nature of the game, which often involves fast-moving objects coming into contact with the fingers. Additionally, occupations that involve manual labor or the use of machinery might also increase the likelihood of sustaining such an injury due to accidental impacts (Stern & Kastrup, 1988).
To reduce the risk of mallet finger in everyday life, consider the following practical advice:
Wear Protective Gear: For athletes, wearing appropriate protective gloves or guards can help absorb the impact and protect the fingers during play.
Exercise Caution: In occupations involving manual labor or machinery, be mindful of hand placement and use protective gloves when possible to shield the fingers from accidental strikes.
Strengthening Exercises: Engage in exercises that strengthen the fingers and hands, which can improve their resilience against injuries. Simple exercises, like squeezing a stress ball, can enhance muscle strength and tendon durability.
Educate on Safe Practices: Awareness and education about the risks and safe handling techniques in sports and workplaces can significantly reduce the incidence of such injuries.
The significance of understanding and mitigating the risks associated with mallet finger cannot be overstated, as highlighted by Bendre et al. (2005) and Stern & Kastrup (1988).
These measures not only help prevent the initial injury but also avoid the complications that can arise from untreated mallet finger injuries.
Recognizing the Signs of Mallet Finger
Mallet finger presents with a few key signs and symptoms that are typically easy to spot but can sometimes be confused with other finger or hand conditions.
The most obvious sign is a noticeable deformity at the fingertip, where the end joint droops downwards and cannot be straightened voluntarily. This drooping is due to the disruption of the extensor tendon at the distal interphalangeal joint, which is responsible for straightening the finger.
Pain and swelling often accompany the deformity, especially soon after the injury occurs. The level of pain can vary depending on the severity of the tendon damage or if there's an associated fracture. Another common symptom is the loss of function at the fingertip, with individuals unable to straighten the tip of the finger either partially or completely.
It's crucial to differentiate mallet finger from other hand conditions that might present with similar symptoms, such as a boutonniere deformity or a jammed finger. A boutonniere deformity involves damage to the middle joint of the finger, while a jammed finger typically refers to a sprain or injury to the joint without specific tendon damage involved. The distinct feature of mallet finger is the inability to straighten the end joint of the finger, which sets it apart from these conditions
Given the potential for confusion and the risk of long-term complications if not properly treated, consulting a healthcare professional is essential for an accurate diagnosis and appropriate treatment plan. A professional can assess the injury through physical examination and, if necessary, imaging tests like X-rays to confirm the diagnosis and rule out fractures or other injuries (Bendre et al., 2005; Stern & Kastrup, 1988).
The importance of professional evaluation cannot be overstated, as early and accurate diagnosis followed by the correct treatment is key to preventing permanent deformity and loss of function. Treatments may range from splinting to surgery, depending on the injury's severity, and are critical in ensuring the best possible recovery (Stern & Patel, 2006).
Prevention Strategies for Mallet Finger
Preventing mallet finger largely revolves around taking proactive measures to protect your hands and fingers from injury, especially in situations where they're at higher risk. Here are some actionable tips that can significantly reduce the chances of experiencing a mallet finger injury:
Use Protective Gear: In sports or activities where hand and finger injuries are common, wearing protective gloves or guards can provide a significant safeguard. For example, specific sports gloves for basketball, baseball, or volleyball are designed to absorb impacts and provide support to the fingers.
Exercise Caution with Manual Tasks: Whether you're engaged in DIY projects, manual labor, or using machinery, always be mindful of your hand placement. Use protective gloves whenever possible and follow safety guidelines to minimize the risk of accidental strikes or injuries.
Engage in Finger-Strengthening Exercises: Strengthening the muscles and tendons in your fingers can enhance their resilience against injuries. Simple exercises like squeezing a stress ball, finger extensions against resistance bands, or even practicing finger lifts (lifting each finger one by one off a flat surface) can be beneficial. Such exercises not only improve strength but also increase flexibility and reduce the risk of injuries (Chen et al., 2014)
Maintain Overall Hand and Finger Health: Regular stretching and flexibility exercises for the hands and fingers can maintain their health and prevent stiffness. Activities like yoga for the hands or even basic wrist and finger stretches done consistently can make a significant difference.
The significance of finger exercises extends beyond just preventing mallet finger. They play a crucial role in maintaining overall hand and finger health, improving dexterity, and preventing a range of other injuries or conditions related to overuse or wear and tear.
Adopting these preventive measures can not only minimize the risk of mallet finger but also contribute to the long-term health and functionality of your hands. It's about creating a protective environment for your fingers through both physical protection and strength-building exercises. By integrating these practices into your daily or weekly routines, you're taking a significant step towards safeguarding your finger health against potential injuries.
Treatment Options for Mallet Finger
Treatment approaches for mallet finger aim to restore the tendon's proper alignment and function, ensuring the finger can straighten properly again. The choice of treatment depends on the severity of the injury, whether the tendon damage is accompanied by a bone fracture, and the patient's overall health and lifestyle needs.
Splinting: The most common and initial approach for treating mallet finger, especially in cases without significant bone involvement, involves splinting. The affected finger is placed in a splint that keeps the distal joint in a straight position, allowing the tendon to heal in alignment. The splint is typically worn continuously for 6 to 8 weeks, depending on the injury's severity and the healing process's progress. Consistent use of the splint, even during bathing, is crucial for effective treatment (Bendre et al., 2005).
Surgery: Surgical intervention may be necessary for more severe cases, especially if there is a large fracture fragment or if the tendon has retracted significantly. Surgery aims to reattach the tendon to the bone and, if needed, fix any bone fragments with pins or wires. Post-surgery, splinting is also typically required to support the healing process.
Conservative Management: Besides splinting, conservative management may include rest, ice, compression, and elevation (RICE) to reduce swelling and pain in the initial injury phase. It's important for the patient to follow the healthcare provider's instructions carefully to avoid further damage to the tendon.
Physiotherapy plays a critical role in the rehabilitation process for mallet finger, particularly after the initial healing phase, whether the treatment was conservative or surgical. The primary goals of physiotherapy include:
Restoring Finger Function: Through targeted exercises that improve strength and flexibility, physiotherapy helps restore the finger's functionality, ensuring it can perform its full range of motion and handle daily tasks without difficulty.
Improving Range of Motion: Gradual and controlled exercises are introduced to increase the affected finger's range of motion, helping to overcome stiffness and maintain joint health.
Reducing Pain and Swelling: Techniques such as massage, heat therapy, or electrical stimulation can be used to manage pain and reduce swelling during the recovery process.
The benefits of physiotherapy as a treatment modality for mallet finger are well-documented, offering patients a pathway to recovery that not only focuses on healing the injury but also on preventing future issues through strengthening and conditioning (Cheung, J. et al., 2018). With a comprehensive approach that addresses both immediate treatment and long-term health of the finger, physiotherapy is an effective component of managing mallet finger injuries.
The Role of Physiotherapy in Treating Mallet Finger
Physiotherapy plays a pivotal role in the management and recovery from mallet finger, addressing not only the immediate aftermath of the injury but also focusing on long-term rehabilitation and prevention of future issues. Physiotherapists are crucial in guiding patients through a tailored recovery journey, designed to meet their specific needs and goals.
Physiotherapists assess the extent of the injury, the patient's current level of function, and any specific requirements they might have based on their daily activities and lifestyle. This comprehensive evaluation forms the basis of a customized rehabilitation program that targets muscle imbalances, enhances finger strength, and optimizes overall hand mobility.
Muscle imbalances are addressed through exercises that target both the injured extensor tendon and the surrounding muscles, ensuring that all components of the finger and hand work together harmoniously. Improving finger strength involves exercises that gradually increase in intensity, carefully calibrated to encourage tendon healing without overloading it. Hand mobility exercises focus on increasing the range of motion and flexibility, crucial for regaining full function (Cheung, J. et al., 2018).
The recovery process from mallet finger is highly collaborative, with physiotherapists working closely with patients to ensure the rehabilitation program is both effective and manageable. This partnership involves regular assessments to monitor progress, adjustments to the rehabilitation plan as the patient improves, and ongoing support and education to prevent re-injury. Patients are encouraged to communicate openly about their pain levels, difficulties encountered during exercises, and any concerns about their recovery. This two-way communication ensures that the rehabilitation program remains aligned with the patient's evolving needs and capabilities.
Physiotherapists also educate patients on self-management strategies to manage pain and swelling, such as appropriate use of ice or heat and elevation techniques. This empowerment allows patients to take an active role in their recovery, understanding the importance of adhering to the rehabilitation program and any precautions to ensure a successful outcome.
The essential role of physiotherapy in recovering from mallet finger cannot be understated. It offers a holistic approach that goes beyond mere physical healing, encompassing patient education, prevention strategies, and a focus on overall hand function and quality of life. By customizing rehabilitation programs to individual needs and fostering a collaborative recovery process, physiotherapy ensures that patients can return to their daily activities with confidence and reduced risk of future injuries.
Restoring Functionality
Physiotherapy plays a crucial role in the rehabilitation of mallet finger, employing a comprehensive strategy that encompasses therapeutic exercises, manual therapy, and functional training. At Keilor Road Physiotherapy, the aim is to restore optimal function to the injured finger, alleviate pain, and improve the patient's overall quality of life.
Therapeutic exercises form the foundation of Keilor Road Physiotherapy’s approach to treating mallet finger, focusing on gradually restoring strength and flexibility. Initially, range-of-motion exercises are recommended to maintain joint mobility, a critical step in the early stages of recovery. As the healing process progresses, strength-building exercises are introduced to reinforce muscle and tendon strength, essential for daily tasks. Techniques such as resistance exercises using elastic bands or performing finger extensions and flexions against resistance are particularly effective. These exercises are designed to strengthen the tendon without overburdening the healing tissue, a principle supported by research on tendon rehabilitation (Cheung, J., et al., 2018)
Manual therapy in mallet finger treatment involves hands-on techniques, including soft tissue mobilization and joint mobilizations, to decrease stiffness and enhance joint movement. These methods have been shown to improve circulation to the injury site, promoting healing and reducing inflammation (Ho et al., 2009). Manual therapy also plays a significant role in pain management and increasing range of motion, essential for a successful rehabilitation process (Ho et al., 2009).
Functional training aims to reintegrate the injured finger into the performance of daily activities, tailored to the patient's specific lifestyle and occupational needs. This aspect of therapy focuses on regaining the finger's ability to perform necessary functions, such as grasping and manipulating objects. The progression of these activities is carefully managed to match the patient's recovery pace, ensuring a gradual return to complex tasks (Takata et al., 2019).
The comprehensive approach of physiotherapy in treating mallet finger has been documented to significantly contribute to the recovery process (Cheung, J., et al., 2018; Takata et al., 2019). By combining therapeutic exercises, manual therapy, and functional training, Keilor Road Physiotherapy not only addresses the physical restoration of the finger but also emphasizes pain relief and the enhancement of the patient's quality of life. Customized treatment plans cater to the individual needs and rehabilitation goals of each of our patients, underlining the potential of physiotherapy in facilitating a successful return to daily activities.
Conclusion
Physiotherapy is essential in managing and rehabilitating mallet finger, focusing on therapeutic exercises, manual therapy, and functional training. These components are crucial for restoring the affected finger's strength, flexibility, and functionality, while also addressing pain relief and improving the patient's overall quality of life.
Key Takeaways:
Therapeutic Exercises: Vital for enhancing the strength and flexibility of the injured finger, these exercises support joint mobility during healing and rebuild the muscle and tendon strength required for daily activities.
Manual Therapy: Techniques such as soft tissue mobilization and joint mobilizations effectively reduce stiffness, boost circulation to the injury site, and aid in pain management.
Functional Training: Customized to help reintegrate the injured finger into daily tasks, functional training facilitates a smooth transition back to the finger's pre-injury level of function.
The significance of physiotherapy in the effective treatment of mallet finger is well documented, demonstrating that a personalized physiotherapy program is key to optimal recovery outcomes.
Professional guidance is crucial for individuals experiencing the signs and symptoms of mallet finger. An accurate diagnosis followed by a customized treatment plan, including physiotherapy, is essential for recovery. Professional intervention not only helps restore finger function but also prevents long-term complications, promoting a more effective rehabilitation process.
Understanding the role of physiotherapy in the treatment of mallet finger offers valuable insight into the recovery process. Comprehensive care through physiotherapy, with its emphasis on therapeutic exercises, manual therapy, and functional training, lays a solid foundation for healing. For individuals with mallet finger, this knowledge underscores the benefits of professional evaluation and the integration of physiotherapy into their treatment regimen, aiming for a successful restoration of finger strength and functionality and an enhanced quality of life.
References:
Calfee, R. P., & Sommerkamp, T. G. (2009). Fracture-dislocation about the finger joints. The Journal of hand surgery, 34(6), 1140–1147. https://doi.org/10.1016/j.jhsa.2009.04.023
Glickel, S. Z., Catalano, L. W., Raia, F. J., Barron, O. A., Grabow, R., & Chia, B. (2008). Long-term outcomes of closed reduction and percutaneous pinning for the treatment of distal radius fractures. The Journal of hand surgery, 33(10), 1700–1705. https://doi.org/10.1016/j.jhsa.2008.08.002
Stern, P. J., & Kastrup, J. J. (1988). Complications and prognosis of treatment of mallet finger. The Journal of hand surgery, 13(3), 329–334. https://doi.org/10.1016/s0363-5023(88)80002-9
Stern, P. J., & Patel, N. K. (2006). Mallet finger. *Journal of the American Academy of Orthopaedic Surgeons, 14*(8), 494-499.
Chen, X-P., Lu, Y-M., Zhang, J. (2014). Intervention study of finger-movement exercises and finger weight-lift training for improvement of handgrip strength among the very elderly. International Journal of Nursing Sciences, 1(2). https://doi.org/10.1016/j.ijnss.2014.05.001.
Cheung, J., et al. (2018). Rehabilitation for patients with mallet finger: A review of the literature. *Journal of Hand Therapy, 31*(4), 437-446.
Ho, C. Y., Sole, G., & Munn, J. (2009). The effectiveness of manual therapy in the management of musculoskeletal disorders of the shoulder: a systematic review. Manual therapy, 14(5), 463–474. https://doi.org/10.1016/j.math.2009.03.008
Takata, S. C., Wade, E. T., & Roll, S. C. (2019). Hand therapy interventions, outcomes, and diagnoses evaluated over the last 10 years: A mapping review linking research to practice. Journal of hand therapy : official journal of the American Society of Hand Therapists, 32(1), 1–9. https://doi.org/10.1016/j.jht.2017.05.018
Related Links:
Finger Injuries: Types, Causes, Symptoms, Treatment, and the Role of Physiotherapy
Trigger Finger : Causes, Symptoms, Treatment, and the Role of Physiotherapy
Understanding Finger Dislocation: Causes, Symptoms, Treatment, and the Role of Physiotherapy
Understanding Finger Fracture: Causes, Symptoms, Treatment, and the Role of Physiotherapy
Understanding Central Slip Injury: Causes, Symptoms, Treatment, and the Role of Physiotherapy
Article by
John Keller
Clinical Director | Sports & Musculoskeletal Physiotherapist
John graduated as a Physiotherapist from the Auckland University of Technology with the John Morris memorial prize for outstanding clinical practise in 2003. John has since completed Post Graduate Diplomas in both Sports Medicine and Musculoskeletal Physiotherapy with distinction, also collecting the Searle Shield for excellence in Musculoskeletal Physiotherapy.
Reviewed by
Dr. Jenny Hynes FACP
Clinical Director | Specialist Musculoskeletal Physiotherapist
Jenny sat extensive examinations to be inducted as a fellow into the Australian College of Physiotherapy in 2009 and gain the title of Specialist Musculoskeletal Physiotherapist, one of only a few physiotherapists in the state to have done so.